DIVING GAS EMBOLISM

Course overview

DIVING USING AN UNDERWATER BREATHING APPARATUS (UBA) OF ANY TYPE INVOLVES INSPIRATION OF COMPRESSED GAS BY THE DIVER AT PRESSURES ABOVE NORMAL SURFACE PRESSURE. SEAWATER IS SUFFICIENTLY DENSER THAN AIR SUCH THAT ONE ATMOSPHERE (ATM) OF AIR IS EQUIVALENT TO 33 FEET OF SEAWATER (FSW), MEANING THAT THE AMBIENT PRESSURE ON A DIVER WILL DOUBLE WITH A DESCENT TO 33 FSW. DURING ANY DIVE, A DIVER IS SUBJECT TO THE LIMITATIONS IMPOSED BY BOYLE'S LAW, WHICH STATES THAT PRESSURE AND VOLUME ARE INVERSELY RELATED. AS PRESSURE DECREASES, THE VOLUME WILL INCREASE PROPORTIONALLY, WHICH MEANS THAT THE SAME DIVER HOLDING HIS BREATH AND ASCENDING FROM 33 FSW WOULD DOUBLE HIS LUNG VOLUME ON RETURN TO THE SURFACE IF THAT WERE ANATOMICALLY POSSIBLE WITHOUT STRUCTURAL DAMAGE TO THE LUNGS. A DIVER WHO HOLDS HIS OR HER BREATH AND ASCENDS FROM AS LITTLE AS 1 METER (APPROXIMATELY 3 FEET) MAY CAUSE AN OVERPRESSURIZATION SUFFICIENT TO RUPTURE LUNG ALVEOLI AND INTRODUCE GAS INTO THE SURROUNDING TISSUES AND/OR BLOOD VESSELS. THIS IS REFERRED TO AS PULMONARY OVERINFLATION SYNDROME AND RESULTS IN ONE OR MORE OVEREXPANSION INJURIES: PNEUMOMEDIASTINUM, PNEUMOTHORAX, SUBCUTANEOUS EMPHYSEMA, OR ARTERIAL GAS EMBOLISM. THIS ACTIVITY REVIEWS THE EVALUATION AND MANAGEMENT OF A DIVING GAS EMBOLISM AND THE ROLE OF INTERPROFESSIONAL TEAM MEMBERS IN COLLABORATING TO PROVIDE WELL-COORDINATED CARE AND ENHANCE PATIENT OUTCOMES.